Listening to Patients

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New Addiction Treatment Implant Will Hit The Market Next Month At $4,950

A graphic shows how the implant is placed inside the skin of a person's upper arm. (Courtesy Braeburn Pharmaceuticals)

A graphic shows how the new addiction treatment implant Probuphine is placed inside the skin of a person’s upper arm. (Courtesy Braeburn Pharmaceuticals)

There’s a new tool in the fight against the nation’s raging opioid epidemic.

The FDA on Thursday approved an implantable version of the drug buprenorphine, which staves off opioid cravings. Labels for the new device are rolling off printing devices today, and trainings begin Saturday for doctors who want to learn to insert the four matchstick size rods into patients.

The implant, called Probuphine, is expected to be available by the end of June.

“This is just the starting point for us to continue to fight for the cause of patients with opioid addiction,” said Braeburn Pharmaceuticals CEO Behshad Sheldon.

But one day after the FDA approved this first long-acting delivery method for buprenorphine, debate continues about how effective the implant will be and whether insurers will cover it.

A Game Changer … Or Set Up For Failure? 

The head of the National Institute on Drug Abuse calls the new implant a game-changer because it will help addiction patients stay on their meds while their brain circuits recover from the ravages of drug use. And addiction experts say it will be much harder for patients prescribed the implant to sell their medication on the street, which is a problem for addiction patients prescribed pills.

“I think it’s fantastic news,” said Dr. Sarah Wakeman, medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital. “We need as many tools in the toolbox as possible to deal with the opioid epidemic.”

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Coming Soon: The Magic Pill, A Daily Dose (By Podcast) Of Get Up And Go

Co-hosts Dr. Eddie Phillips and CommonHealth's Carey Goldberg record The Magic Pill in a WBUR studio. Photo: Robin Lubbock)

Co-hosts Dr. Eddie Phillips of Harvard Medical School and CommonHealth’s Carey Goldberg record The Magic Pill. (Photo: Robin Lubbock)

Dear reader,

Your presence on this page suggests that you’re interested in health. So perhaps you’d be interested to know that WBUR is about to launch a short, lively podcast aimed at helping you do just about the very best thing you can do for your health: Move more. (The experts tell us not to use turn-off terms like “exercise” and “work out.” It’s not supposed to be work. It’s supposed to be fun and feel good.)

We’re calling it “The Magic Pill,” because exercise (Oops. I mean, physical activity…) is the closest thing we have to a magic pill for our health. If you’ve read some of our scores of “Why To Exercise Today” posts over the years, you probably already have that impression.

The Magic Pill will be a 21-day challenge, uplifting you every day for three weeks this fall with compelling stories, fascinating facts and gotta-move music — all in a “micro-podcast” of under 10 minutes. What better boost to help you start your day?

As a CommonHealth reader and public radio fan, you can help — we hope — in two ways:

• Sign up now for The Magic Pill — by clicking here. The 21-day challenge won’t begin until Sept. 1, so it won’t hinder any summer slacking.

• As we produce the podcast, we’ll be looking for stories from people who exemplify certain themes. For example, how does exercise affect your mood? Have you “fallen off the wagon,” and how did you get back on? Did you undergo a “conversion experience” to exercise or just make small, gradual changes? If you’d be interested in receiving our questions once a week or so and possibly sharing your story, please post a note in the comments below. Or if you’d like to nominate someone else as a fitness inspiration, please click here. And thanks!  

Popping A Daily Baby Aspirin? Caution: New Guidelines, Amid Controversy

New recommendations from the USPSTF recommend aspirin for far fewer people. (M. Spencer Green/AP)

New recommendations from the USPSTF recommend aspirin for far fewer people. (M. Spencer Green/AP)

When an older woman arrived at a Cambridge medical clinic recently, Dr. Sarah Stoneking was surprised to learn that the patient was taking an aspirin every day.

The patient was nearly 80, and didn’t have a clear reason to take the medication. Aspirin in general, and especially in older patients, can have a lot of side effects, including serious bleeding.

Stoneking, an internist and also my colleague, suggested her patient stop taking the daily aspirin, but the woman refused. She thought aspirin “was a panacea,” Stoneking recalled, one that protected her from the strokes and heart disease that had affected most of her friends. “She took it religiously,” Stoneking said.

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Deal Would Take Controversial Hospital Pricing Question Off Ballot

It was to be a game of high stakes politics with hundreds of millions of health care dollars on the line. But on Wednesday the players negotiated a truce — with help from unified leaders on Beacon Hill — to prevent a November ballot question on hospital prices.

“It is my hope that this plan will avert a costly and divisive ballot initiative and lend assistance to our community hospitals,” said House Speaker Robert DeLeo in a statement.

The ballot initiative that brought DeLeo, Senate President Stan Rosenberg and Gov. Charlie Baker together aimed to close the gap between high and low cost hospitals. It proposed cutting $463 million in payments to the state’s more expensive hospitals and redistributing that money to struggling community hospitals and to consumers through lower premiums.

The Massachusetts Hospital Association opposed the plan. MHA President Lynn Nicholas is relieved to hear voters won’t be asked to adjust price differences between her members.

“The most important aspect of this resolution is not doing complicated public policy through a blunt instrument at the ballot box,” Nicholas said.

The ballot question was proposed by a health care workers union, 1199SEIU. Estimates showed the state’s largest private employer, Partners Healthcare, would have lost more than $400 million a year.

The influential union and the top employer have been in and out of offices on Beacon Hill for weeks, negotiating roughly a half dozen different plans that would have legislators instead of voters settle the hospital price gap problem.

“The most important aspect of this resolution is not doing complicated public policy through a blunt instrument at the ballot box.”

– Lynn Nicholas

The consensus deal announced Wednesday includes some more money for community hospitals — at least $20 to $25 million a year, divided between several dozen hospitals. Some hospitals would benefit and some would lose if an additional hospital assessment of $250 million is approved and distributed through Medicaid payments. The union says it is pleased. Continue reading

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When The Therapist Has A Fear Of Elevators

(Allen Lai/Flickr)

(Allen Lai/Flickr)

The cramped elevator in the office building where I practice psychotherapy makes me uneasy.

The carpet looks stained and worn, fraying in the corner. Faded yellow paint barely covers the walls. When the door slides open, a musty smell hits the nostrils of waiting passengers.

I rode this contraption for the first time nine years ago, the day I decided to rent my office. That first trip felt like a movie in slow motion. The machine noisily inched up its shaft, lurching and wheezing like a drunk asthmatic. The seconds dragged by. When the elevator reached the third floor, it grew oddly still. Nothing happened. While I waited for the door to spring to life, I felt my heart thumping in my chest. Silently, I willed that thick, motionless metal portal to move, imagining myself imprisoned in this tiny cell for hours, mouth parched and desperate for a sip of water.

Finally, the elevator car shuddered, and the door slid open. I bolted out, ran down the hall to my new office and tried to catch my breath.

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How Doctors Think About In-Flight Medical Emergencies

In-flight medical emergencies occur about 44,000 times a year worldwide, according to a 2013 report, and physicians assist in about half of the emergencies. (Courtesy of Chris Brignola/Unsplash)

In-flight medical emergencies occur about 44,000 times a year worldwide, according to a 2013 report, and physicians assist in about half of the emergencies. (Courtesy of Chris Brignola/Unsplash)

I am not a nervous flier by nature, but on the first flight I took as a newly minted doctor, I sat at uneasy attention. I was trying to relax, but my professor’s words kept echoing in my head: “When you get on a flight, you are no longer just another passenger. You’re the doctor on board.”

I’ve not yet witnessed an in-flight emergency, but many of my colleagues already have, and I know that for me and many other new doctors just finishing medical school this month, flying will never be the same.

Dr. Judy Kwok, a doctor in my training program, has been involved in two medical emergencies in the air. The first was on a flight to Hong Kong. She remembers the overhead call for a doctor filled her with “complete dread,” she told me. She walked to the front of the plane to see a woman sitting up but initially unresponsive. The woman looked sick. “What happened?” Kwok asked, amidst the chaos. Many passengers were offering opinions — most unhelpful.

The sick woman began to speak, but not in English. A passenger quickly stepped up to translate. Finally, Kwok got the story: The woman had chest pain. A medical student had also responded and took vitals. The flight attendants — who are trained to respond to these emergencies — also arrived to help. They offered her an emergency medical kit, stocked with basic supplies and medications mandated by the Federal Aviation Association. Concerned the woman might be having a heart attack, Kwok gave her aspirin and continued to monitor her.

The flight attendants radioed an emergency call center. Kwok asked if they could divert the plane, but was told by the physicians who staff the center that their flight was over Mongolia. Continue reading

Exercise Addiction: How To Know If You’ve Crossed The Line Between Health And Obsession

Experts say it’s tricky to determine precisely how many people struggle with exercise addiction because it can masquerade behind socially acceptable intentions -- like getting fit at the gym. (Courtesy of Scott Webb/Unsplash)

Experts say it’s tricky to determine precisely how many people struggle with exercise addiction because it can masquerade behind socially acceptable intentions — like getting fit at the gym. (Courtesy of Scott Webb/Unsplash)

Lisa M. joined a gym as soon as she started college at Bridgewater State University, determined not to pack on an extra 15 pounds freshman year like her older sister.

“In my head there was that picture of my sister,” Lisa said in an interview. “I didn’t want that to happen to me.”

For the next six years, Lisa says, she never missed a day at the gym unless it was preplanned and she could make it up later. In order to fulfill her self-imposed exercise requirements, Lisa skipped Christmas Eve gatherings, birthdays, weddings and dates with someone she loved and “very likely lost” because of her illness, she says.

“Every aspect of my life was dictated by exercise and food and the need to control it all,” says Lisa, who asked that her last name not be used because she is still in treatment.

“Every aspect of my life was dictated by exercise and food and the need to control it all.”

– Lisa M.

The thought of missing even one daily workout triggered massive anxiety, she says. And as her exercise obsession deepened, she began restricting her food intake too, mostly to salads and vegetables. She had “fear foods” she’d avoid: no cake, brownies or cookies, of course, but also, no cheese or pasta. Thoughts about food and exercise consumed her: “Any extra energy I had would go to…thinking about my next meal, my next snack, what I’d be able to eat next. I’d plan meals a week ahead.”

Her weight dropped to 112 pounds on a 5-foot-6 frame. She hasn’t had a period in six years. Now, as a result, Lisa, who is 25, has osteoporosis in her lower spine and hip.

“I worked so hard to be healthy, but I’m not,” she says. “And I did this to myself.” Continue reading

Opinion: Why Medical Students Are Good For Your Health

(Monash University/Flickr)

While the presence of medical students may make some patients uneasy, one student explains how these future doctors can benefit patient care. (Monash University/Flickr)

If you have ever been admitted to a teaching hospital, you’ve probably encountered a medical student in your midst. You might wonder: Is this student actually here to help me, or am I a guinea pig here to help them learn? While the presence of budding doctors may make some patients uneasy, these students often grapple with their own anxieties about the transition out of the classroom and into the hospital room.

When I first started my clinical rotations, I felt apologetic about my presence in the hospital. Having spent the majority of the first two years of medical school in the classroom, I had limited real-life experience and seemingly little to contribute. I worried that I was an impediment to my clinical teams. Or worse, that my presence was a nuisance to patients. Then I met Jack and my view began to change.

Jack was a scrawny 3-year-old boy with a shaved head, huge smile and squishy cheeks. He was admitted to the hospital with worsening asthma. He arrived onto our hospital floor coughing and wheezing as his mom struggled to hold him still.

Our medical team — which consisted of three physicians and two students — determined during our evaluation that the child would need to receive albuterol, a drug used in asthma management, every few hours via an inhaler. As the student assigned to follow Jack, it was my job to examine him every one to two hours — more frequently than any of the physicians on my team — and report back on his status. Before I went home, I signed out to the overnight staff that he was breathing more comfortably.

The next morning, the overnight physicians reported that there had been some miscommunication between the physicians, respiratory therapists and nurses. Jack had not received several doses of his albuterol but had still slept through most of the night. One of the physicians had reevaluated Jack one hour before I arrived. He had been sleeping peacefully.

I jotted down these overnight events and went to see Jack. He was now wide awake, squirming in his bed and working hard to breathe. Continue reading

The Promise And Price Of New Addiction Treatment Implant

Amid a raging opioid epidemic, there’s a plea for more treatment options. The Food and Drug Administration expects to have a decision on one by May 27.

It’s an implant. Four rods, each about the size of a match stick, inserted in the upper arm. This new device, called Probuphine, delivers a continuous dose of an existing drug, buprenorphine, but with better results, says implant maker Braeburn Pharmaceuticals.

A graphic shows how the implant is placed inside the skin of a person's upper arm. (Courtesy Braeburn Pharmaceuticals)

A graphic shows how the implant is placed inside the skin of a person’s upper arm. (Courtesy Braeburn Pharmaceuticals)

In clinical trials, 88 percent of patients with the implants abstained from opioids, as compared to 72 percent of those taking buprenorphine as a daily pill. (Buprenorphine is commonly referred to by its brand name, Suboxone.)

“I felt completely normal all the time,” said Dave, a paramedic in a small town outside Boston who was on the implant during a clinical trial. He does not want his last name made public so that coworkers won’t find out he is addicted to opioid pain pills.

Dave, 47, has been in recovery for four years with the help of buprenorphine. Dave said he prefers the implant to the pills for several reasons. With the pills he would sometimes feel the drug wear off. He worried about his 2-year-old granddaughter getting into the bottle. And sometimes Dave would just forget to take his medication, which he’s supposed to do in the morning, 15 minutes before he has anything to eat or drink.

“With the implant you didn’t have to worry about that, you just, it was just there and you felt good all the time,” Dave said.

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Boston Medical Center Launches First Comprehensive Transgender Medical Center In Northeast

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Boston Medical Center CEO Kate Walsh was in a meeting a few years ago when something about gender identity and health came up. She turned to Dr. Joshua Safer, who was treating many of the hospital’s transgender patients.

“I said, ‘So you really believe patients are born in the wrong bodies?’ ” Walsh recalls, looking at Safer across a conference room table as she tells the story. “You said, ‘Yes,’ and that’s how we started on this journey to help people live the lives they were meant to live.”

The journey lead to the creation of the Center for Transgender Medicine and Surgery at BMC, the first such comprehensive service in the Northeast. It brings together services the hospital has been building out for several years: primary care, hormone therapy and mental health support, as well as chest and facial reconstruction procedures. Later this summer, as part of the comprehensive center, the hospital will begin genital surgery for men transitioning to women.

“This is very exciting for me to see us stepping up to do this,” said Safer, who will direct the center. “If you look across North America, there are only a handful of surgeons doing this sort of thing.”

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